Meeting WHO’s Conditions For Labor Augmentation: A Narrative Literature Review on South Asia and A linked Analysis Using DHS 2016 and SPA 2015 Surveys in Nepal

• Author / Creator

  Noor, Rafat

• Background:
  Labor augmentation using oxytocin is commonly used throughout the world, but certain precautions need to be taken, and certain conditions need to be met; otherwise, complications are possible for both mothers and babies.
  Method:
  We conducted a narrative literature review study to gather evidence on the administration of oxytocin during labor, its resulting adverse effects on mothers and babies, and the circumstances where the WHO’s conditions for such practice are met or not met in both homebirth and hospital birth settings in South Asia. In addition, we conducted a cross-sectional study utilizing Nepal Demographic Health Survey (DHS) 2016 data and Nepal Service Provision Assessment (SPA) Survey 2015 data to assess the extent of labor augmentation practice without following the WHO recommended conditions in case of hospital births in Nepal (excluding the primary level hospitals). By geographically linking the Nepal DHS 2016 birth dataset and Nepal SPA 2015 Inventory dataset, the closest hospital (secondary or tertiary level) to each DHS cluster was identified; and those hospitals were categorized into ‘apparently ready’ (all 4 of the following criteria met: surgeon and anesthetist available, blood available, and cesarean deliveries done over the preceding 3 months), ‘possibly ready’ (cesarean deliveries done over the preceding 3 months but not all of the 4 criteria for “apparently ready” were met) and ‘definitely not ready’ (no cesarean deliveries over the preceding 3 months or cesarean deliveries are usually not offered in that hospital) [according to SPA data] to manage complications for labor augmentation. Bivariate analyses, including proportions of birth received oxytocin during labor disaggregated by different types of place of delivery, types of residences (urban/rural), and different provinces in Nepal, were conducted depending on data availability; the significance of differences was reported using a chi-square test. In addition, a multinomial logistic regression model was utilized to assess the association of women’s socio-economic factors with labor augmentation received in ‘possibly ready’ and ‘definitely not ready’ hospitals compared to ‘apparently ready’ hospitals.
  Result:
  Our literature review findings suggest that using oxytocin during labor without following the WHO’s labor augmentation recommendations is common in both home and hospital births in South Asia. The common adverse outcomes of such injudicious practice include uterine rupture, birth asphyxia, and stillbirth. Our quantitative analyses reported that, based on the DHS 2016 data, 66.9% (95%CI: 56.7%, 75.7%) of mothers who delivered at home, attended by a health worker, and responded to the labor augmentation specific survey question received oxytocin during labor; for hospital births, these proportions were- 64.3%( 95% CI: 59.1%, 69.1%) and 52.9% (95% CI: 49.1%, 56.8%) in private hospitals and public hospitals, respectively. The geographically linked analysis reported that 50.4% (95% CI: 45.7%, 55.2%) of DHS reported government hospitals births for which the closest government hospital is categorized as ‘apparently ready-for labor augmentation’ received oxytocin during labor, 57.5% (95% CI: 48.4%, 66.1%) of DHS reported government hospital births for which the closest hospital is categorized as ‘possibly ready-for labor augmentation’ received oxytocin during labor, and 55.0% (95% CI: 47.5%, 62.7%) of DHS reported government hospital births for which the closest hospital is categorized as ‘definitely not ready-for labor augmentation’ received oxytocin during labor; for private hospital births, these proportions are 69.7% (95% CI: 60.9%, 77.4%), 52.5% (95% CI: 37.4%, 67.1%) and 62.5% (95% CI: 55.9%, 68.7%), respectively. In view of these proportions, we can say that the practice of labor augmentation in every level of healthcare delivery is considerably high, including settings without adequate readiness to manage its complications. Besides, our multinomial logistic regression model reported that, for the DHS reported private hospital births, women’s socio-economic factors have a significant association with receiving labor augmentation in a ‘definitely not ready’ hospital compared to ‘apparently ready’ hospital- women with secondary level education compared to no education [RRR: 2.56, (95% CI 1.12, 5.82)], women with higher education compared to no education [RRR: 3.72, (95%CI: 1.20, 11.47)], women in richest wealth index compared to poorest wealth index RRR: 0.04, (95% CI: <0.01, 0.38). However, for the govt. hospital births, women’s socio-economic factors did not seem to influence the facts of receiving labor augmentation in hospitals with adequate readiness to manage its complications.

• Subjects / Keywords

  • Maternal Health
  • Newborn Health
  • Labor augmentation
  • Labor induction
  • Oxytocin
  • Uterotonics
  • Facility readiness
  • Compliance to conditions
  • South Asia
  • Nepal
  • Ensuring safety

• Graduation date

  Spring 2022

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-t13f-pb91

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.